Liver abscess usually shows a moderate leucocytosis with a normal polymorphonuclear percentage and an increase of large mononuclears and transitionals to about 12 to 20%.
According to Schilling-Torgau we may have a perfectly normal white count and polymorphonuclear percentage and yet have evidence of the presence of liver abscess in his modification of Arneth’s index, so that in an apparently normal differential count we may find that ½ or more of the polymorphonuclears are of a less mature type and in cases where there are many immature polymorphonuclears we have indications which force a very cautious or unfavorable prognosis.
Thus a differential count of 33% band-form polymorphonuclears and 39% of normal nucleated ones would make us give a cautious prognosis, while one with 1% myelocytes, 22.5% immature polymorphonuclears, 21% band-form nucleated ones and 30% of normal ones would make for a very bad prognosis. We have a displacement to the left. Normally there are 63% of normal polymorphonuclears, 4% of band-form and no immature ones or myelocytes.
One may find an iodophilia in liver abscess.
Of the functional liver tests we may determine the ammonia quotient, the percentage of N eliminated as ammonia being increased in abscess of the liver. The same is true of the lipase test. Probably the most specific test for disturbances of the hepatic function is that for urobilinogen. The test is made by adding 5 to 10 drops of Ehrlich’s aldehyde reagent to 5 cc. of perfectly fresh urine when a positive reaction gives a fine cherry-red color.
Prophylaxis and Treatment
Prophylaxis.—The prophylaxis is the same as that for amoebic dysentery plus avoidance of anything which reduces the functional power of the liver, such as overfeeding, alcoholic excesses, etc.
It is well to remember that abscesses may occur months or even two or three years after an attack of amoebic dysentery, consequently it is well to give a grain of emetine on two or three successive days of each month following an acute attack.
Treatment.—Leaving out of consideration the pre-suppurative stage of amoebic hepatitis which, according to many authorities, responds to injections of emetine, it may be stated that the treatment of liver abscess is entirely surgical and such treatment should be instituted the moment the diagnosis is made. The earlier a liver abscess is drained the less run down will be the patient, the more rapid the convalescence and the better the prognosis.
Until recently surgical authorities condemned severely the trocar and cannula method of operation, but with the introduction of emetine there are now those who believe that such a procedure may suffice and a more radical operation not be necessitated.